Procedural Outcomes and Conduction System Capture Pattern Maintenance with the Tendril STS™ 2088TC Lead and CPS Locator™ 3D Delivery System: A Comparative Analysis with Lumenless Lead System

Introduction: Left bundle branch area pacing (LBBAP) is typically performed using the lumenless (LLL) Medtronic SelectSecure TM Model 3830 pacing lead. Stylet driven leads (SDL) for LBBAP were recently introduced. Objective: To compare the Abbott Tendril STS TM 2088TC SDL and CPS Locator TM 3D delivery system to the Medtronic LLL and delivery system acutely and chronically. Methods: : Fifty consecutive patients who received SDL using the CPS Locator TM 3D delivery system for standard pacing indications were included in this study. A comparison was made with 229 LLL patients from a retrospective database, evaluating baseline characteristics, procedural outcomes, lead and system performance, and follow-up data. Results: : LBBAP was successful in 84% of SDL and 79% of LLL patients (p = 0.55), with no significant differences in procedural characteristics or complications. Minor pacing differences were noted. CPS Locator TM 3D performed similarly to C315His ® delivery system with a trend for less lead placement attempts. Conduction system capture (CSC) pattern at implant did not differ between both groups. CSC maintenance was similar between SDL and LLL. However, follow-up QRS duration was significantly longer in SDL group (154ms vs 129ms, p=0.004) suggesting a possibility of CSC loss in some patients. Conclusion: SDL is a viable alternative to LLL demonstrating comparable acute and mid-term pacing parameters. CPS Locator TM 3D delivery system showed comparable performance and excellent safety profile. Acute CSC with SDL and LLL is similar, but its long-term maintenance will require further study.